When compared with other hypertension drugs, beta blockers, especially atenolol, are no better at preventing myocardial infarction and come with an increased risk of stroke, according to a meta-analysis published online Oct.18, ahead of print in The Lancet.

Investigators searched the Cochrane Library and PubMed for trials involving patients with primary hypertension who were treated with beta blockers. They included 13 randomized, controlled trials involving 105,951 patients in a meta-analysis comparing beta blockers with other hypertension drugs. They also analyzed seven studies involving 27,433 patients to compare the use of beta blockers with the use of placebo or no treatment.

The relative risk of stroke was 16 percent higher for patients who took beta blockers when compared with other hypertension drugs. There was no difference in MI. The increased risk of stroke was most prominent with atenolol, the researchers observed. They also noted that in the non-atenolol trials of 9,004 patients, there were not enough clinical events for the results to be conclusive.

Compared with placebo or no treatment, treatment with beta blockers reduced the risk of stroke by 19 percent. However, the investigators said this rate was approximately half the expected rate, based on previous trial results. Again, they found no difference in MI.

Based on the results of the meta-analysis, the researchers concluded that "beta blockers should not remain as first choice in the treatment of primary hypertension and should not be used as reference drugs in future randomized, controlled trials of hypertension."

An accompanying editorial pointed out that some patients do need beta blockers as a first-line treatment, and there are "distinct theoretical hazards" associated with the rapid discontinuation of beta blocker therapy, especially for patients who may already be at higher risk for coronary events.

"Is this the end of beta blockers altogether, or just of atenolol?" the editorialist asked, noting that newer beta blockers such as GlaxoSmithKline Plc's Coreg (carvedilol) have other potential benefits, including vasodilating properties.